Effects of Increasing Balance Task Difficulty on Postural Sway and Muscle Activity in Healthy Adolescents

Nonlinear dynamics of postural control system under visual-vestibular habituation balance practice: evidence from EEG, EMG and center of pressure signals

Human postural control system is inherently complex with nonlinear interaction among multiple subsystems. Accordingly, such postural control system has the flexibility in adaptation to complex environments. Previous studies applied complexity-based methods to analyze center of pressure (COP) to explore nonlinear dynamics of postural sway under changing environments, but direct evidence from central nervous system or muscular system is limited in the existing literature. Therefore, we assessed the fractal dimension of COP, surface electromyographic (sEMG) and electroencephalogram (EEG) signals under visual-vestibular habituation balance practice. We combined a rotating platform and a virtual reality headset to present visual-vestibular congruent or incongruent conditions. We asked participants to undergo repeated exposure to either congruent (n = 14) or incongruent condition (n = 13) five times while maintaining balance. We found repeated practice under both congruent and incongruent conditions increased the complexity of high-frequency (0.5-20 Hz) component of COP data and the complexity of sEMG data from tibialis anterior muscle. In contrast, repeated practice under conflicts decreased the complexity of low-frequency (<0.5 Hz) component of COP data and the complexity of EEG data of parietal and occipital lobes, while repeated practice under congruent environment decreased the complexity of EEG data of parietal and temporal lobes. These results suggested nonlinear dynamics of cortical activity differed after balance practice under congruent and incongruent environments. Also, we found a positive correlation (1) between the complexity of high-frequency component of COP and the complexity of sEMG signals from calf muscles, and (2) between the complexity of low-frequency component of COP and the complexity of EEG signals. These results suggested the low- or high-component of COP might be related to central or muscular adjustment of postural control, respectively.

Short- and Long-Term Changes in Balance After Active Video Game Training in Children With and Without Developmental Coordination Disorder: A Randomized Controlled Trial

Active video games (AVG) have been used as training tools and are known to ameliorate balance performance in children with Developmental Coordination Disorder (DCD). Our aim was to evaluate balance using clinical tests and by measuring body sway using a force plate with a mixed design of vision (eyes open/eyes closed), surface (rigid/soft), and support (stance/semitandem) before, and after, training and 4 months later (follow-up). Thirty-six DCD children and 40 typically developing children participated in the study, of which 50 children (26 DCD; 24 typically developing) were retested after 4 months. Balance improved on the clinical measures after the training, which was independent of type of AVG (Wii-Fit and Xbox Kinect) used, and this effect was still present after 4 months. The AVG training did not influence general sway behavior, but only sway in the eyes-open condition, corresponding with task demands of the training and indicating a training-specific effect. Overall, DCD children and typically developing children responded comparably to the AVG training, thereby maintaining the gap in performance between the two groups. The changes in postural sway are interpreted as a sign of more confidence and less freezing of the joints, enabling greater flexibility of movements and balance strategies as supported by the improved performance on balance tests in the DCD children. This is the first study that showed long-term effects of AVG training on balance performance. However, these follow-up results should be interpreted with caution given that 35% of the children were lost in follow-up.

Effect of Exergame Intervention on Balance Ability of Adolescents: A Randomized Controlled Trial

Objective: Balance is a strong indicator of physical development of adolescents, and there is a trend of employing exergame for balance training. However, the effectiveness of exergame specifically designed for balance training on adolescents' balance abilities in various postures remains unclear. Materials and Methods: In this study, an exergame for balance training was developed with Kinect and a randomized controlled trial was conducted to assess its effect on balance ability development. Thirty-two healthy adolescents (age: 11.44 ± 0.51) were recruited to participate in an 8-week trial and randomly allocated to an exergame group (N = 16) or control group (N = 16). Results: The static balance test in the eagle stance posture and the dynamic balance test using the Y-Balance Test were both conducted before and after the intervention. From the results of Mann-Whitney U test, the intervention group presented greater improvement during the eagle stance test with eyes closed than the control group with P = 0.009 and P = 0.03 in left and right leg, respectively. The intervention group also showed a more significant improvement in dynamic balance (P = 0.002), which was reflected by the higher increase of composite scores. Furthermore, the balance ability when standing with nondominant leg or eyes closed, both presented higher improvements than standing with dominant leg or eyes opened, respectively. Moreover, 75% participants reported high interest and 87.5% participants expressed high engagement with exergame (score ≥4) using 5-score scale questionnaire. Conclusion: The proposed exergame for balance training could potentially promote balance training and serve as an educational tool for healthy adolescents to enhance their balance abilities.

Child-Adult differences in antagonist muscle coactivation: A systematic review

Antagonist coactivation is the simultaneous activation of agonist and antagonist muscles during a motor task. Age-related changes in coactivation may contribute to observed differences in muscle performance between children and adults. Our aim was to systematically summarize age-related differences in antagonist muscle coactivation during multi-joint dynamic and single-joint isometric and isokinetic contractions. Electronic databases were searched for peer-reviewed studies comparing coactivation in upper or lower extremity muscles between healthy children and adolescents/young adults. Of the 1083 studies initially identified, 25 met eligibility criteria. Thirteen studies examined multi-joint dynamic movements, 10 single-joint isometric contractions, and 2 single-joint isokinetic contractions. Of the studies investigating multi-joint dynamic contractions, 83% (11/13 studies) reported at least one significant age-related difference: In 84% (9/11 studies) coactivation was higher in children, whereas 16% (2/11 studies) reported higher coactivation in adults. Among single-joint contractions, only 25% (3/12 studies) reported significantly higher coactivation in children. Fifty six percent of studies examined females, with no clear sex-related differences. Child-adult differences in coactivation appear to be more prevalent during multi-joint dynamic contractions, where generally, coactivation is higher in children. When examining child-adult differences in muscle function, it is important to consider potential age-related differences in coactivation, specifically during multi-joint dynamic contractions.

Balance Therapy With Hands-Free Mobile Robotic Feedback for At-Home Training Across the Lifespan

Providing aging adults with engaging, at-home balance therapy is essential to promote long-term adherence to unsupervised training and to foster independence. We developed a portable interactive balance training system that provides real-world visual cues on balance performance using wobble board tilt angles to control the speed of a robotic car platform in a three-dimensional environment. The goal of this study was to validate this mobile balance therapy system for home use across the lifespan. Twenty younger (18-39 years) and nineteen older (58-74 years) healthy adults performed balance training with and without visual feedback while standing on a wobble board instrumented with a consumer-grade inertial measurement unit (IMU) and optical motion tracking markers. Participants performed feedback trials based on either the robotic car's movements or a commercially-available virtual game. Wobble board tilt measurements were highly correlated between IMU and optical measurement systems ( [Formula: see text]), with high agreement in outcome metrics ( [Formula: see text]) and small bias ( [Formula: see text]). Both measurement systems identified similar aging, feedback, and stance type effects including (1) altered movement control when older adults performed tilting trials with either robotic or virtual feedback compared to without feedback, (2) two-fold greater wobble board oscillations in older vs. younger adults during steady standing, (3) no difference in board oscillations during steady standing in narrow vs. wide double support, and (4) greater wobble board oscillations for single compared to double support. These findings demonstrate the feasibility of implementing goal-directed robotic balance training with mobile tracking of balance performance in home environments.

Directed network analysis reveals changes in cortical and muscular connectivity caused by different standing balance tasks

Objective.Standing balance forms the basis of daily activities that require the integration of multi-sensory information and coordination of multi-muscle activation. Previous studies have confirmed that the cortex is directly involved in balance control, but little is known about the neural mechanisms of cortical integration and muscle coordination in maintaining standing balance.Approach.We used a direct directed transfer function (dDTF) to analyze the changes in the cortex and muscle connections of healthy subjects (15 subjects: 13 male and 2 female) corresponding to different standing balance tasks.Main results.The results show that the topology of the EEG brain network and muscle network changes significantly as the difficulty of the balancing tasks increases. For muscle networks, the connection analysis shows that the connection of antagonistic muscle pairs plays a major role in the task. For EEG brain networks, graph theory-based analysis shows that the clustering coefficient increases significantly, and the characteristic path length decreases significantly with increasing task difficulty. We also found that cortex-to-muscle connections increased with the difficulty of the task and were significantly stronger than the muscle-to-cortex connections.Significance.These results show that changes in the difficulty of balancing tasks alter EEG brain networks and muscle networks, and an analysis based on the directed network can provide rich information for exploring the neural mechanisms of balance control.

Effects of Physical and Mental Fatigue on Postural Sway and Cortical Activity in Healthy Young Adults

Physical fatigue (PF) negatively affects postural control, resulting in impaired balance performance in young and older adults. Similar effects on postural control can be observed for mental fatigue (MF) mainly in older adults. Controversial results exist for young adults. There is a void in the literature on the effects of fatigue on balance and cortical activity. Therefore, this study aimed to examine the acute effects of PF and MF on postural sway and cortical activity. Fifteen healthy young adults aged 28 ± 3 years participated in this study. MF and PF protocols comprising of an all-out repeated sit-to-stand task and a computer-based attention network test, respectively, were applied in random order. Pre and post fatigue, cortical activity and postural sway (i.e., center of pressure displacements [CoP_d], velocity [CoP_v], and CoP variability [CV CoP_d, CV CoP_v]) were tested during a challenging bipedal balance board task. Absolute spectral power was calculated for theta (4–7.5 Hz), alpha-2 (10.5–12.5 Hz), beta-1 (13–18 Hz), and beta-2 (18.5–25 Hz) in frontal, central, and parietal regions of interest (ROI) and baseline-normalized. Inference statistics revealed a significant time-by-fatigue interaction for CoP_d (p = 0.009, d = 0.39, Δ 9.2%) and CoP_v (p = 0.009, d = 0.36, Δ 9.2%), and a significant main effect of time for CoP variability (CV CoP_d: p = 0.001, d = 0.84; CV CoP_v: p = 0.05, d = 0.62). Post hoc analyses showed a significant increase in CoP_d (p = 0.002, d = 1.03) and CoP_v (p = 0.003, d = 1.03) following PF but not MF. For cortical activity, a significant time-by-fatigue interaction was found for relative alpha-2 power in parietal (p < 0.001, d = 0.06) areas. Post hoc tests indicated larger alpha-2 power increases after PF (p < 0.001, d = 1.69, Δ 3.9%) compared to MF (p = 0.001, d = 1.03, Δ 2.5%). In addition, changes in parietal alpha-2 power and measures of postural sway did not correlate significantly, irrespective of the applied fatigue protocol. No significant changes were found for the other frequency bands, irrespective of the fatigue protocol and ROI under investigation. Thus, the applied PF protocol resulted in increased postural sway (CoP_d and CoP_v) and CoP variability accompanied by enhanced alpha-2 power in the parietal ROI while MF led to increased CoP variability and alpha-2 power in our sample of young adults. Potential underlying cortical mechanisms responsible for the greater increase in parietal alpha-2 power after PF were discussed but could not be clearly identified as cause. Therefore, further future research is needed to decipher alternative interpretations.

Resilience of visually guided weight shifting to a proprioceptive perturbation depends on the complexity of the guidance stimulus

BACKGROUND

Whole-body tracking of visual motion cues is used in balance training to improve weight shifting ability in old age and sports.

RESEARCH QUESTION

How tracking of a complex (pink noise) and a periodic visual target motion during anteroposterior weight shifting affects postural and muscle responses to unilateral hip vibration.

METHODS

Twenty-six participants performed 160 anteroposterior weight shifting cycles while tracking the vertical motion of a visual target, concurrently receiving Center of Pressure (CoP) feedback. They were randomly divided to groups; (a) the Constant group tracked a visual target motion constructed by 3 sinusoids of different amplitude, and (b) the Pink group tracked a complex visual target motion constructed by a pink noise generation process. Between the 60th and the 120th cycle, vibration was applied to the right gluteus medius, introducing a sideways CoP deviation. CoP displacement and electromyographic (EMG) responses of soleus, tibialis anterior and peroneus longus were recorded and summarized in blocks of 3 cycles.

RESULTS

Sideways CoP deviation induced at the onset/offset of unilateral hip vibration was smaller for the Pink than the Constant group. The Pink group demonstrated greater tibialis anterior and peroneus longus EMG activity around the most anterior sway peak while soleus EMG was similar for the two groups. Both groups successfully coupled weight shifting amplitude to the target motion, but the Pink group tracked the target motion with a greater delay compared to the Constant group.

SIGNIFICANCE

Whole body tracking of complex visual motions evokes perception-based action and increases ankle muscle co-activation making sway more resilient to a proprioceptive perturbation induced by unilateral hip vibration. Complex visual guidance motions should be considered when designing balance rehabilitation regimes, aiming at improving weight shifting ability and dynamic balance control.

Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predictability

The aim of this study was to quantify balance impairments in standing in people with degenerative cervical myelopathy (PwDCM) in response to external perturbations. PwDCM have damage to their spinal cord due to degeneration of the cervical vertebral column, but little is known about balance. Balance was quantified by capturing kinetics, kinematic, and electromyographic data during standing in response to lateral waist pulls. Participants received pulls during predictable and unpredictable contexts in three stance widths at two magnitudes. In response to lateral waist pulls, PwDCM had larger center of mass excursion (P < 0.001) and delayed gluteus medius electromyography onset (P < 0.001) and peak (P < 0.001) timing. These main effects of history of myelopathy were consistent across predictability, stance width, and magnitude. A multilinear regression determined that gluteus medius peak timing + tibialis anterior peak timing most strongly predicted center of mass excursion (R² = 0.50, P < 0.001). These data suggest that PwDCM have delays in generating voluntary and reactive motor commands, contributing to balance impairments. Future rehabilitation strategies should focus on generating rapid muscular contractions. Additionally, frontal plane postural control is regulated by the gluteus medius and the tibialis anterior, whereas other muscles (e.g. gluteus minimus, ankle invertors/evertors) not studied here may also contribute.NEW & NOTEWORTHY Frontal plane reactive postural control is impaired in persons with degenerative cervical myelopathy because of delayed muscle responses. Additionally, postural control varies across stance width, predictability, and perturbation magnitude.

Postural control in adolescent boys and girls before the age of peak height velocity: Effects of task difficulty

BACKGROUND

Adolescent children experience a critical developmental period marked by rapid biological changes. Research question To describe the longitudinal changes in postural control that occur in adolescent boys and girls before the age of peak height velocity (PHV).

METHODS

Here, to address the gap of knowledge, we compared the postural control and activation strategies of the muscles that control the ankle joint in twenty-three boys (age 12.5 ± 0.29) and twenty-one girls (age 10.5 ± 0.32). They performed easy (two legs) and difficult (two legs-eyes closed; one leg) postural balance tasks at 18 and 9 months before PHV and at PHV. We quantified the center of pressure (COP) displacements in the anterior-posterior (AP) and mediolateral (ML) directions and electromyographic (EMG) activity of tibialis anterior (TA) and medial gastrocnemius (MG) muscles.

RESULTS

Boys exhibited greater AP and ML COP displacement than girls only for the one leg task (difficult task). Although boys and girls had similar postural control 18 months prior to PHV, girls exhibited lesser COP displacement at 9 months before PHV, which related to greater TA-MG coactivation (R² = 0.26; p < 0.01). In contrast, postural control was not different between boys and girls with an easy balance task (two legs) performed with eyes open and closed. Rather, we found that all children improved their COP displacement in the ML direction with maturity and both AP and ML COP was significantly lower with eyes open.

CONCLUSION

These findings provide novel evidence that postural control is superior in early adolescent girls than boys 9 months prior to PHV, likely associated with an earlier maturation of muscle coordination.

Acute effects of a single unilateral balance training session on ipsi- and contralateral balance performance in healthy young adults

Objective

While there is evidence on the short-term effects of unilateral balance training (BT) on bipedal balance performance, less is known on the acute effects of unilateral BT on unilateral (i.e., ipsi- and contralateral) balance performance. Thus, the present study examined the acute effects of a single unilateral BT session conducted with the non-dominant, left leg or the dominant, right leg on ipsilateral (i.e. retention) and contralateral (i.e., inter-limb transfer) balance performance in healthy young adults (N = 28).

Results

Irrespective of practice condition, significant improvements (p < 0.001, d = 1.27) in balance performance following a single session of unilateral BT were observed for both legs. Further, significant performance differences at the pretest (p = 0.002, d = 0.44) to the detriment of the non-dominant, left leg diminished immediately and 30 min after the single unilateral BT session but occurred again 24 h following training (p = 0.030, d = 0.36). These findings indicate that a single session of unilateral BT is effective to reduced side-to-side differences in balance performance, but this impact is only temporary.

Effects of task difficulty during practice on learning a dynamic balance task in healthy young adults: An intervention study

OBJECTIVE

Cross-sectional studies reported increased postural sway during balance tasks with a high (e.g., unipedal stance on foam ground) compared to a low (e.g., unipedal stance on firm ground) level of task difficulty. Therefore, practicing/training balance tasks using high compared to low stimuli seems to be beneficial as it addresses larger adaptive reserves. Thus, the present study was performed to investigate the role of task difficulty during practice on learning a dynamic balance task in healthy young adults.

RESULTS

During acquisition, both practice groups ("Easy" or "Difficult" task condition) significantly improved their performance (i.e., time in balance). Further, the statistical analysis of post-practice performance revealed a significant main effect of test (i.e., better performance under easy compared to difficult test conditions, irrespective of group) but not of group. Additionally, the Group × Test interaction did not reach the level of significance, indicating that learning a dynamic balance task did not depend on the practiced task condition.

Biomechanical analysis of single-leg stance using a textured balance board compared to a smooth balance board and the floor: A cross-sectional study

BACKGROUND

Previous research showed that standing on textured surfaces can improve postural control by adapting somatosensory inputs from the plantar foot. The additional stimulation of plantar cutaneous mechanoreceptors by a textured surface during single-leg stance on a balance board may increase afferent information to the central nervous system to accelerate muscular responses and to enhance their accuracy. The additional impact of textured surface during single-leg stance on a balance board on postural control and muscle activity is unknown.

RESEARCH QUESTION

To investigate the differences of a) postural control during single-leg stance on a textured balance board compared to a smooth balance board and b) activity of lower extremity muscles during single-leg stance on a textured balance board compared to a smooth balance board and the floor.

METHODS

Twenty-six healthy adults (12 females, 14 males; mean age = 25.4 years) were asked to balance on their randomly assigned left or right leg on a force plate (floor; stable condition), a textured balance board and a smooth balance board (unstable conditions). Center of pressure (CoP) displacements (force plate, Bertec, 1000 Hz) and electromyographic activity (EMG) of eight leg muscles were measured and compared between conditions, respectively.

RESULTS

Neither CoP-displacements, nor EMG activities differed significantly between the textured and the smooth balance board (p > 0.05). Significantly higher muscle activities (p < 0.05) were observed using the balance boards compared to the floor.

SIGNIFICANCE

Single-leg stance using a textured balance board seems not to lead to reduced CoP-displacements compared to a smooth balance board. Muscle activation is significantly increased in both balance board conditions compared to the floor, however, it is not different when both balance board surfaces are compared. It could not be recommended to use a textured balance board for altering muscle activity and improving postural control during single-leg stance in favor of a smooth textured balance board.

Effects of balance training on balance performance in youth: role of training difficulty

BACKGROUND

Cross-sectional studies have shown that balance performance can be challenged by the level of task difficulty (e.g., varying stance conditions, sensory manipulations). However, it remains unclear whether the application of different levels of task difficulty during balance training (BT) leads to altered adaptations in balance performance. Thus, we examined the effects of BT conducted under a high versus a low level of task difficulty on balance performance.

METHODS

Forty male adolescents were randomly assigned to a BT program using a low (BT-low: n = 20; age: 12.4 ± 2.0 yrs) or a high (BT-high: n = 20; age: 12.5 ± 2.5 yrs) level of balance task difficulty. Both groups trained for 7 weeks (2 sessions/week, 30-35 min each). Pre- and post-training assessments included measures of static (one-legged stance [OLS] time), dynamic (10-m gait velocity), and proactive (Y-Balance Test [YBT] reach distance, Functional Reach Test [FRT]; Timed-Up-and-Go Test [TUG]) balance.

RESULTS

Significant main effects of Test (i.e., pre- to post-test improvements) were observed for all but one balance measure (i.e., 10-m gait velocity). Additionally, a Test x Group interaction was detected for the FRT in favor of the BT-high group (Δ + 8%, p < 0.001, d = 0.35). Further, tendencies toward significant Test x Group interactions were found for the YBT anterior reach (in favor of BT-high: Δ + 9%, p < 0.001, d = 0.60) and for the OLS with eyes opened and on firm surface (in favor of BT-low: Δ + 31%, p = 0.003, d = 0.67).

CONCLUSIONS

Following 7 weeks of BT, enhancements in measures of static, dynamic, and proactive balance were observed in the BT-high and BT-low groups. However, BT-high appears to be more effective for increasing measures of proactive balance, whereas BT-low seems to be more effective for improving proxies of static balance.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN83638708  (Retrospectively registered 19th June, 2020).

Balance task difficulty affects postural sway and cortical activity in healthy adolescents

Electroencephalographic (EEG) research indicates changes in adults’ low frequency bands of frontoparietal brain areas executing different balance tasks with increasing postural demands. However, this issue is unsolved for adolescents when performing the same balance task with increasing difficulty. Therefore, we examined the effects of a progressively increasing balance task difficulty on balance performance and brain activity in adolescents. Thirteen healthy adolescents aged 16–17 year performed tests in bipedal upright stance on a balance board with six progressively increasing levels of task difficulty. Postural sway and cortical activity were recorded simultaneously using a pressure sensitive measuring system and EEG. The power spectrum was analyzed for theta (4–7 Hz) and alpha-2 (10–12 Hz) frequency bands in pre-defined frontal, central, and parietal clusters of electrocortical sources. Repeated measures analysis of variance (rmANOVA) showed a significant main effect of task difficulty for postural sway (p < 0.001; d = 6.36). Concomitantly, the power spectrum changed in frontal, bilateral central, and bilateral parietal clusters. RmANOVAs revealed significant main effects of task difficulty for theta band power in the frontal (p < 0.001, d = 1.80) and both central clusters (left: p < 0.001, d = 1.49; right: p < 0.001, d = 1.42) as well as for alpha-2 band power in both parietal clusters (left: p < 0.001, d = 1.39; right: p < 0.001, d = 1.05) and in the central right cluster (p = 0.005, d = 0.92). Increases in theta band power (frontal, central) and decreases in alpha-2 power (central, parietal) with increasing balance task difficulty may reflect increased attentional processes and/or error monitoring as well as increased sensory information processing due to increasing postural demands. In general, our findings are mostly in agreement with studies conducted in adults. Similar to adult studies, our data with adolescents indicated the involvement of frontoparietal brain areas in the regulation of postural control. In addition, we detected that activity of selected brain areas (e.g., bilateral central) changed with increasing postural demands.